Route/Dosage

PO (Adults): Hypertension– 10 mg 4 times daily initially. After 2–4 days may ↑ to 25 mg 4 times daily for the rest of the 1st wk; may then ↑ to 50 mg 4 times daily (up to 300 mg/day). Once maintenance dose is established, twice-daily dosing may be used. HF– 25–37.5 mg 4 times daily; may be ↑ up to 300 mg/day in 3–4 divided doses.

Availability (generic available)

Assessment

Monitor BP and pulse frequently during initial dose adjustment and periodically during therapy. About 50–65% of Caucasians, Black, South Indians, and Mexicans are slow acetylators at risk for toxicity, while 80–90% of Eskimos, Japanese, and Chinese are rapid acetylators at risk for decreased levels and treatment failure.

Implementation

May be administered concurrently with diuretics or beta blockers to permit lower doses and minimize side effects.

PO Administer with meals consistently to enhance absorption.

Pharmacist may prepare oral solution from hydralazine injection for patients with difficulty swallowing.

IV Administration

IV Push: Diluent: Administer undiluted. Use solution as quickly as possible after drawing through needle into syringe. Concentration: 20 mg/mL.

Rate: Administer over at least 1 min. Pedi: Administer at a rate of 0.2 mg/kg/min in children. Monitor BP and pulse in all patients frequently after injection.

Y-Site Compatibility

alemtuzumab

amiodarone

anidulafungin

argatroban

bivalirudin

bleomycin

carmustine

cyclophosphamide

dacarbazine

dactinomycin

daptomycin

daunorubicin hydrochloride

dexrazoxane

diltiazem

docetaxel

etoposide

etoposide phosphate

fenoldopam

fludarabine

gemcitabine

granisetron

hetastarch

hydromorphone

idarubicin

irinotecan

leucovorin

linezolid

mesna

metronidazole

milrinone

mitomycin

mitoxantrone

moxifloxacin

mycophenolate

octreotide

oxaliplatin

paclitaxel

palonosetron

pamidronate

pancuronium

prochlorperazine

tacrolimus

thiotepa

tirofiban

topotecan

vecuronium

vinblastine

vincristine

vinorelbine

vitamin B complex with C

voriconazole

zoledronic acid

Y-Site Incompatibility

acyclovir

amphotericin B deoxycholate

amphotericin B lipid complex

ampicillin/sulbactam

ascorbic acid

azathioprine

cefazolin

cefotaxime

cefotetan

cefoxitin

ceftazidime

ceftriaxone

cefuroxime

dantrolene

diazepam

doxorubicin liposomal

ertapenem

folic acid

foscarnet

fosphenytoin

ganciclovir

haloperidol

indomethacin

lorazepam

methylprednisolone

multivitamins

nafcillin

nitroprusside

oxacillin

pantoprazole

pemetrexed

pentobarbital

phenytoin

piperacillin/tazobactam

potassium acetate

sodium acetate

tigecycline

trimethoprim/sulfamethoxazole

Patient/Family Teaching

Emphasize the importance of continuing to take this medication, even if feeling well. Instruct patient to take medication at the same time each day; last dose of the day should be taken at bedtime. Take missed doses as soon as remembered; do not double doses. If more than 2 doses in a row are missed, consult health care professional. Must be discontinued gradually to avoid sudden increase in BP. Hydralazine controls but does not cure hypertension.

May occasionally cause drowsiness. Advise patient to avoid driving or other activities requiring alertness until response to medication is known.

Caution patient to avoid sudden changes in position to minimize orthostatic hypotension.

Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications, especially cough, cold, or allergy remedies.

Instruct patient to notify health care professional of medication prior to treatment or surgery.

Advise patient to notify health care professional immediately if general tiredness; fever; muscle or joint aching; chest pain; skin rash; sore throat; or numbness, tingling, pain, or weakness of hands and feet occurs. Vitamin B6 (pyridoxine) may be used to treat peripheral neuritis.

Advise patient to notify health care professional if pregnancy is planned or suspected or if breast feeding.

Emphasize the importance of follow-up exams to evaluate effectiveness of medication.